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Colorado announces Medicaid expansion in 2014

Gov. John Hickenlooper announced Thursday Colorado will expand Medicaid eligibility to cover as many as 160,000 more Coloradans beginning Jan. 1, 2014, and that cost-control savings will help pay for bringing new patients under the program’s umbrella.

The Affordable Care Act of 2010 asks states to offer Medicaid coverage to people with income at or below 133 percent of the federal poverty line starting next year. Medicaid already is available to pregnant women and children age 6 or younger with a household income at or below that level. But eligibility standards vary for other Medicaid-qualifying populations, including people with disabilities, senior citizens and adults without dependent children.

Medicaid coverage for children age 7 to 18 and their parents, for example, is currently limited to people with a household income at or below 100 percent of the federal poverty level, which is $11,172 a year for one person. Under the new rules, anyone who earns as much as $14,868 per year (plus up to $439 for every additional family member) would qualify for Medicaid.

States are allowed to keep Medicaid eligibility at current levels, something nine states have indicated they will do. Colorado became the 15th state to announce plans to move forward with a higher eligibility level, according to an analysis by research agency The Advisory Board Company.

Although the expansion is nearly a year away, legislative action is needed this year to change state law to enhance and continue incentives for fraud prevention, care coordination and an emphasis on quality of care over quantity of care. Hickenlooper said in a news release Thursday savings from those efforts to reduce health care costs should pay for the additional cost of covering more people with Medicaid.

The state partners with the federal government to fund Colorado’s 669,203 current Medicaid patients, but the federal government plans to pay for the cost of covering people who qualify for Medicaid under the new rules for the first three years. After that, Colorado’s responsibility for the expansion will gradually increase to 10 percent in 2020.

“Not one dollar from the state’s general fund will be used for this expansion, even in 2017 when the federal government begins to reduce its share,” Hickenlooper said in the news release.

Dr. Michael Pramenko, executive director of Primary Care Partners, said he supports the expansion because he believes it will lead to fewer uninsured people going to the emergency room and increasing costs for other patients when they can’t pay. Medicaid has gone through some tough budget cuts at the state level in recent years, though, Pramenko said, so he wants the expansion to coincide with reforms, some of which were suggested in Thursday’s announcement. In particular, Pramenko values moving toward a physician reimbursement system that rewards good health outcomes instead of reimbursing care providers by the number of procedures and tests they perform.

Even though Mesa County has more than 200 physicians and practices that offer primary care and family medicine to Medicaid patients, according to the Department of Health Care Policy and Financing, many can only take on a certain amount of Medicaid patients and remain solvent due to a Medicaid reimbursement rate of 33 cents for every dollar of care provided. The offer of a federal subsidy to enroll people with an income between 125 and 400 percent of federal poverty level to help people enroll in a private insurance exchange will help medical providers offset the increase in Medicaid patients, Pramenko predicted, as long as reimbursements do not decrease.

“If the funding is inadequate, there will still be an access problem,” he said.

Kristy Schmidt, interim executive director at Marillac Clinic, said she doesn’t expect to see more patients at the clinic next year, just more existing patients who qualify for Medicaid. The clinic mostly serves uninsured Mesa County residents but began to accept a limited number of Medicaid patients in 2012 after the state began offering Medicaid coverage to adults without dependent children who have an income at or below 10 percent of the federal poverty line.

“We became (Medicaid) providers to be able to provide that continuity so if they were an established patient with Marillac, we could continue their care,” Schmidt said. “I think if some (existing patients) are already established with us, they may want to continue with us, even if they qualify for Medicaid.”